Havalad Suresh, Quaid Maureen A, Sapiega Vytautas
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Advocate Lutheran General Children's Hospital, 1775 Dempster St, Park Ridge, IL 60068, USA.
Nutr Clin Pract. 2006 Apr;21(2):175-81. doi: 10.1177/0115426506021002175.
The purpose of this study was to test the hypotheses that estimates of resting energy expenditure (REE) vary significantly from measured energy expenditure in a population of head-injured children and are not accurate for use in determining nutrition needs in this population.
This is a retrospective study of 30 children with severe head injury, with Glasgow Coma Scale (GCS) score of <8 and needing mechanical ventilation. Measured REE was obtained using indirect calorimetry. Estimated REEs were calculated using Harris-Benedict, World Health Organization (WHO), Schofield, and White formulas. Severity of illness was calculated using Pediatric Risk of Mortality (PRISM) score. Agreement between measured REE and estimated REE was tested using the Bland-Altman method. Correlation coefficient between PRISM score and measured REE was calculated using Spearman test.
More than half of the estimates of REE differed from measured REE by >10%. Significant disagreement between estimated REE and measured REE was demonstrated using the Bland-Altman method. There was no correlation between severity of illness and measured REE to explain the inaccuracies of REE estimates.
Energy expenditure in critically ill children cannot be estimated accurately; hence, nutrition for critically ill children with head injury should be provided according to measurement of REE to avoid the consequences of overfeeding or malnutrition.
本研究的目的是检验以下假设：在一群头部受伤的儿童中，静息能量消耗（REE）的估计值与测量的能量消耗有显著差异，并且在确定该人群的营养需求时不准确。
这是一项对30名重度头部受伤儿童的回顾性研究，格拉斯哥昏迷量表（GCS）评分<8且需要机械通气。使用间接测热法获得测量的REE。使用哈里斯-本尼迪克特公式、世界卫生组织（WHO）公式、斯科菲尔德公式和怀特公式计算估计的REE。使用儿科死亡风险（PRISM）评分计算疾病严重程度。使用布兰德-奥特曼方法检验测量的REE与估计的REE之间的一致性。使用斯皮尔曼检验计算PRISM评分与测量的REE之间的相关系数。
超过一半的REE估计值与测量的REE相差>10%。使用布兰德-奥特曼方法证明了估计的REE与测量的REE之间存在显著差异。疾病严重程度与测量的REE之间没有相关性来解释REE估计值的不准确。
危重症儿童的能量消耗无法准确估计；因此，对于头部受伤的危重症儿童，应根据REE测量提供营养，以避免过度喂养或营养不良的后果。
